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PHAR 154 > Constipation > Flashcards

Constipation Flashcards

1
Q

What is considered constipation

A

Less then 3 bowel movements/week that are hard, lumpy, or difficult to pass

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2
Q

Causes of constipation

A

Narcotics
Dehydration
Colon cancer
Elderly
Travel

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3
Q

Complications of constipation

A

Hard stools, rectal bleeding, hemorrhoids

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4
Q

Etiology of constipation

A

“Not a normal part of aging”
Normal is different for everyone
Majority of cases are harmless

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5
Q

What conditions do we need to be cautious with for constipation?

A

Medication-induced constipation
Diabetes
Colon cancer
IBS

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6
Q

When to refer for constipation

A

Longer than 3 days w/o bowel movement
OR 1 week with at-home treatment

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7
Q

Red flags in constipation

A

Changes in stool textures
Blood in stool
Hemorrhoids
Weight loss
Decreased appetite
N+V
Frequent pain
Narrower stools
Unresponsive to treatment

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8
Q

Causes of large bowel obstruction

A

Cancer or large stool

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9
Q

Symptoms of large bowel obstruction

A

Belly cramping and pain
Belly swelling and bloating
Unable to pass gas and stool
Vomiting
More then what is seen in constipation and IBS-C

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10
Q

Non drug treatments for constipation

A

Fluid
Fibre
Exercise

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11
Q

How much fluid should someone with constipation have?

A

Men - 2L
Women - 1.6L

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12
Q

How much fibre should someone with constipation have?

A

For 19-30yo
Men - 34g
Women - 28g

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13
Q

What kind of fibre is best?

A

Insoluble

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14
Q

What is a natural laxative?

A

Prunes

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15
Q

What do prunes contain that is useful for constipation?

A

Insoluble and soluble fibre
Also contain sorbitol - most value here

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16
Q

What are the agents of choice for prevention of constipation?

A

Bulk-forming agents

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17
Q

MOA of bulk forming agents

A

Swells in intestinal fluid -> creates gel -> facilitates passage
Takes a few days to work
Needs intake of fluid

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18
Q

What is a one of the bulk-forming agents?

A

Psyllium (Metamucil)

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19
Q

MOA of psyllium (Metamucil)

A

Increases fecal mass within 48-72 hours

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20
Q

How often do you take psyllium?

A

TID

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21
Q

Side effects of psyllium

A

Psyllium induced obstruction if patient cannot drink much fluid
- Pain, cramps, nausea, no fecal output

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22
Q

When is stool softener useful?

A

For prevention
Common on maternity wards and with palliative care

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23
Q

Efficacy of stool softener

A

LESS effective than bulk-forming agents

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24
Q

What is drug in stool softener?

A

Docusate (colace)

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25
Q

Dosing for docusate

A

1-2 caps/day
4 caps/day for nursing homes
Up to 8 in palliative care

26
Q

How long does docusate take to work?

A

1-2 days

27
Q

When is docusate contraindicated

A

With mineral oil

28
Q

What is used as a lubricant for constipation?

A

Mineral oil

29
Q

MOA of mineral oil

A

Softens fecal matter by coating it

30
Q

Side effect of mineral oil

A

Anal seepage
Lipid pneumonia when laying down -> avoid HS

31
Q

What are the mineral oil products?

A

Fleet MO enema - works extremely quick
Agarol
Magnolax
Lanosyl - yummy jelly

32
Q

When is saline(osmotic) useful for constipation?

A

For bowel evac exams (works within hours)
For bowel evac for acute constipation (Fleet)(works within minutes
General use - overnight relief (Philips)

33
Q

MOA of saline

A

Put non-absorbable ions into gut drawing water into the gut

34
Q

Efficacy of saline

A

NOT useful for seniors due to NO systemic effect

35
Q

What is non-saline osmotic?

A

Glycerin suppositories
Lactulose syrup
PEG 3350

36
Q

Who are glycerin suppositories the agent of choice for?

A

Infants and kids

37
Q

MOA of glycerin suppositories

A

Osmotic effect and local irritant effect
Bowel evac within 30 minutes

38
Q

Side effects of Lactulose syrup

A

Bloating and gas

39
Q

What is the DOC for prevention therapy?

A

PEG 3350

40
Q

What does label use say for PEG 3350?

A

Use <7 days unless MD
NOT for kids <18yo unless MD

41
Q

What are the stimulants (rescue agents)?

A

Senna (senokot)
Exlax
Dulcolax

42
Q

When are stimulants useful?

A

Use if NO BM for 3 days when also using preventative agents
For overnight relief

43
Q

MOA of stimulants

A

Irritants/stimulates Ca2+ channels
To stimulate pulsing in the gut

44
Q

How fast to stimulants work?

A

Within 6-12 hours

45
Q

Side effects of stimulants

A

Bisacodyl and senna are minimally absorbed
Diarrhea/cramps

46
Q

What are the herbal products?

A

Senna, psyllium, bran, aloe, rhubarb

47
Q

What is probiotics use in constipation?

A

Helps with proper digestion and regularity

48
Q

Prevention ambulatory care

A

Dietary efforts&raquo_space; medications
Exercise / fluid intake / prune juice
Bulk forming agents / docusate / PEG 3350 / Lactulose

49
Q

Acute treatment for ambulatory care

A

Senna
Bisacodyl
MoM

50
Q

Red flags in ambulatory care

A

Unexplained new onset / worsening
Blood in stools
Weight loss
Anorexia
Fever
N+V
Family history of colorectal cancer

51
Q

Prevention in long-term care

A

Lactulose vs PEG 3350
Docusate
Bulking agents

52
Q

Acute treatment for long-term care

A

Fleet or micro lax or suppository

53
Q

What is normal BM for infants

A

1 BM per each feed to 1 per week
Breast fed ~3/day and formula ~2/day

54
Q

Cause of constipation in infants

A

Starting solid foods
Not getting enough fluids

55
Q

Causes of contraption in children

A

Too busy to poop
Dietary
Toilet training issues

56
Q

What % of women experience constipation during pregnancy?

A

50%

57
Q

Is iron a major cause of constipation in pregnancy?

A

No

58
Q

Treatment for pregnancy

A

Docusate - VERY COMMON
PEG 3350 - well tolerated
Psyllium - well tolerated but just a little less

59
Q

What should NOT be used for treatment in pregnancy?

A

Senna/bisacodyl - uterine contraction concern
MoM = category B

60
Q

Why do diabetics have less BMs?

A

Nerves are damaged

61
Q

Treatment options for palliative care

A

Stool softeners - good for prevention
Osmotic laxatives - first line therapy
Stimulant - commonly used
Bulk forming - not recommended

62
Q

Treatment for drug-induced constipation

A

D/c as many worrisome agents as possible
Add fibre
Add MoM or PEG 3350
Rescue agent

PHAR 154 (9 decks)

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